Biomedical Ethics in the Christian Narrative Case Study

Applying the Four Principles: Case Study

Part 1: Chart (60 points)

Individuals seek medical interventions based on their conditions and their decisions informed by a host of factors. Imperatively, nurses and other healthcare providers should follow guidelines based on ethical principles and other frameworks like religious beliefs and practices (Gillon, 2018). The case study on “Healing and Autonomy” shows the different aspects that impact the delivery of care in different care settings. The decisions by James’s parents are based on their religious beliefs and faith while at the same time founded on exercising the biomedical ethical principles based on the four quadrant approach. The purpose of this paper is to discuss the different aspects of the case by using the four quadrant approach to ethical issues.

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Medical Indications

Beneficence and Nonmaleficence Patient Preferences

Autonomy

 Medication indications refer to facts, data, and opinions based on assessment about a patient’s condition and their diagnosis (Teven et al., 2018). Medication indications also show the level of severity associated to a medical issue and determines the best course of action and treatment.

Beneficence and non-maleficence are ethical principles that implore medical practitioners and nurses to offer the best care to a patient based on their condition (Gillon, 2018). In this case, James suffers from a kidney failure problem that has exacerbated because of delays in treatment when the parents decided to take him to the healing services at their church but the effort never succeeded. Therefore, James requires a dialysis as a short-term intervention and a kidney transplant in the long as observed and determined by the physician based on the principles of beneficence and non-maleficence.  Patient preferences entail the choices and options that are available to them based on their conditions. Patient preferences arise from the principle of autonomy which implies that one has the right to make their independent decisions without any undue influence (Nissen et al., 2021). Patients have preferences and make informed choices based on the amount of information provided by healthcare workers or physicians. Again, patients make decisions and choices when they have the capacity based on their age.

In this case, James is a minor and his parents make the decisions and choices for him as they exercise his autonomy as surrogates. James does not have the capacity to make choices. Patient preferences and the principle of autonomy protects and preserves the dignity of patients and improves their knowledge about their diseases. Imperatively, James parents, Mike and Joanne, make decisions based on their preferences like taking their son for a healing service at the church and returning him again. The physician and his team cannot make any decisions since the patient has autonomy.

Quality of Life

Beneficence, Nonmaleficence, Autonomy Contextual Features

Justice and Fairness

The quality of life as the third aspect of the quadrant focuses on the relevant medical and health features of a patient’s life before and after the treatment intervention. Healthcare providers’ aim is to enhance the quality of life based on the principles of beneficence, non-maleficence and autonomy (Gillon, 2018). Healthcare providers avoid possible errors and ensure patient safety by providing necessary information to patients and their families so that they can make effective care decisions and choices.

In the case study, the quality of life depends on the treatment interventions that James gets to improve his deteriorating condition because of the kidney failure. His quality of life is disintegrated and continues to get worse until he gets a long-term remedy, a kidney transplant from a matching one, like his twin brother, Samuel.  Therefore, his parents should adhere to the medical advice and make choices and decisions that will improve his quality of life. They should make decisions not based on their Christian beliefs but on sound medical advice from the physician and his team. Contextual features focus on the social, legal and environmental issues; including family aspects that can impact the delivery of quality care interventions to patients and health populations (Teven et al., 2018). These factors like religious practices affect the quality of care and access to health care resources to attain justice and fairness which emphasize equality and health equity (Nissen et al., 2021). The current situation affects different aspects of the contextual features that include familial relationships and interactions as the physician recommends that James can get a matching kidney from his twin brother, Samuel. The parents are willing to let people donate their kidneys but not Samuel as they fear that they may lose both sons. However, they should be fair and just to allow James to access resources, including his brother’s kidney to attain quality life and remedy the situation.

Part 2: Evaluation

Answer each of the following questions about how the four principles and four boxes approach would be applied:

1. In 200-250 words answer the following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)

The Christian worldview emphasizes demonstration of sacrificial love for those in such situations like sickness. Christians believe that taking selfless actions and decisions are a reflection of Christ’s love for humanity and can lead to better interactions among families and communities. In this case, the four principles of beneficence, non-maleficence, autonomy and justice are critical and should be specified and weighted based on their effects on the patient and the family. The first principle is beneficence as illustrated by the decisions and actions taken by the parents (Nissen et al., 2021). Mike and Joanne want the best for their son and the physician and his team are also interested in the best outcomes. The parents exercise autonomy or independence and make the decision based on faith. Therefore, they should not be blamed for their actions. They brought James back when his condition got worse implying that they never wanted to harm his health based on the principle of non-maleficence.

The parents exercise independent judgment based on the principle of autonomy and bring back James to the hospital so that he can get better care from the team. They have the best interest for their son and make efforts to have church members donate their kidneys but unfortunately, none matches James’. The implication is that the principle of justice emerges as the church members are willing to share their vital organs to ensure that James lives as opposed to his current situation. They want to ensure that the boy’s quality of life improves through a long-term solution like a transplant.

2. In 200-250 words answer the following: According to the Christian worldview, how might a Christian balance each of the four principles in this case? Explain why. (45 points)

According to the Christian worldview, patient’s best interest should be a priority and override all actions and decisions in care provision. As such, a Christian’s ranking of the four principles would be dynamic to ensure that patients attain benefits. The Christian balances the need for benefits with ascertaining that there is no harm or commission of actions that endanger the patient or individual getting treatment (Teven et al., 2018). Beneficence should be ranked first and be balanced by non-maleficence as no one should be harmed, including the patient, in efforts to offer care. Love implores all to show their sacrificial commitment to people, especially those who require God’s mercies.

Justice and fairness is the third most critical principle as Christians are taught values of fairness and being just to all. In this case, James’ parents should balance the need for protecting Samuel from possible adverse effects due to kidney donation and the life of the sick boy. Through this approach, they will make better decisions and allow the physician to perform his duties better to save the life of the boy. The last principle to be balanced is autonomy. According to the Christian worldview, autonomy cannot override the need for common good of the many, especially the suffering and troubled. Therefore, the family while practicing this principle should also emphasize the benefits allowing others to make suggestions on the best approach to the issue.

Conclusion

The case study on “Healing and Autonomy” demonstrates the need for patients and their families to understand the different aspects of care provision that impact their decisions and choices. James’ parents have the liberty to make decisions that are relevant and based on the best interests of their son. They should allow the physician and his team to carry out a kidney transplant as the best intervention to improve the quality of life of James. While they exercise the four principles, they should remember that their Christian worldview is not against medical interventions.

Gillon, R. (2018). Principlism, virtuism, and the spirit of oneness. In Health Ethics, Law and

Professionalism (pp.45-59). Routledge.

Nissen, R. D., & Hvidt, N. C. (2021). Assessing patients’ spiritual needs in healthcare: An

overview of questionnaires. Spiritual Needs in Research and Practice, 59-78. https://doi.org/10.1007/978-3-030-70139-0_5

Teven, C. M. & Gottlieb, L. J. (2018). The Four-Quadrant Approach to Ethical Issues in Burn

Care. AMA Journal of Ethics, 20(6): 596-601.

DOI: 10.1001/journalofethics.2018.20.6.vwpt1-1806.

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